=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730450669
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST BELLFORT PEDIATRIC CLINICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2012
-----------------------------------------------------
Last Update Date | 01/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8527 W BELLFORT ST #B
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77071-2265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-981-6002
-----------------------------------------------------
Fax | 713-981-7409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3631 HANSFORD PL
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77584-4990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-981-6002
-----------------------------------------------------
Fax | 713-981-7409
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/DIRECTOR
-----------------------------------------------------
Name | DR. IFEYINWA PATIENCE ONWUDIWE
-----------------------------------------------------
Credential | MD,
-----------------------------------------------------
Telephone | 713-981-6002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | N1405
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------